Healthcare Provider Details

I. General information

NPI: 1457100398
Provider Name (Legal Business Name): MARIA LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WASHINGTON ST STE 206
DORCHESTER MA
02124-5538
US

IV. Provider business mailing address

4 STANLEY CT
CHICOPEE MA
01020-2033
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-5572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10006032
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: